低分子肝素钙诱导血小板减少症患者抗凝治疗的药学监护

Pharmaceutical Care of Anticoagulant Therapy in Patients with Heparin-Induced Thrombocytopenia

目的:探讨低分子肝素钙诱导血小板减少症(HIT)发生后,临床药师在患者后续抗凝治疗中的作用,总结临床药师参与和实施个体化用药监护的药学实践模式。方法:本院收治了1例肿瘤合并血栓的患者,给予低分子肝素钙抗凝治疗后出现重度血小板降低。临床药师利用药学专业知识,及时分析和评估药物不良反应,协助医师制定个体化抗凝治疗方案,并对患者进行用药教育。结果:医师采纳临床药师建议并更换抗凝治疗方案后,患者血小板逐渐上升并恢复至正常范围,顺利出院。结论:临床药师参与临床实践,优化抗凝药物治疗方案,为临床减少药害事件、保障用药安全性发挥了积极作用。

Objective:To explore the role of clinical pharmacists in subsequent anticoagulant therapy of patients with heparin-induced thrombocytopenia(HIT),and to summarize the pharmaceutical practice mode of clinical pharmacists participating in and implementing individualized medication monitoring.Methods:A patient with tumor and thrombus was admitted to our hospital,and then severe thrombocytopenia was observed after treatment with low-molecular-weight heparin calcium.Clinical pharmacists analyzed and evaluated the adverse drug reactions(ADR)timely by using pharmaceutical expertise,assisted physicians to develop individualized anticoagulant therapy programs,and also carried out medication education for the patients.Results:After the doctor adopted the treatment plan recommended by the clinical pharmacist and changed the anticoagulant therapy,the patient s platelets gradually rise to the normal range,and discharged eventually.Conclusion:The participation of clinical pharmacists in clinical practice and the optimization of anticoagulant drug therapy can play a positive role in reducing drug incidents and ensuring drug safety in clinic.